Finasteride (Propecia/Proscar)

Currently there are only two hair loss drugs that actually work. They have been clinically proven to have a real degree of effectiveness. These two medications, Propecia and Rogaine, are also the only two drugs that are approved by the Federal Drug Administration (FDA) for the treatment of hair loss

Finasteride is a medication that prevents the conversion of testosterone to its more active form, DHT (dihydrotestosterone) by inhibiting an enzyme called 5-alpha reductase type II in the scalp hair follicles. Lower levels of DHT in the scalp can slow down or prevent hair loss. However, because finasteride does not completely block this conversion, it will not complete arrest hair loss.

What evidence do we have that finasteride (Propecia/Proscar) works?
Finasteride has been tested extensively all around the world by scientists and doctors in large clinical trials and was found to be very effective in treating male pattern baldness (androgenetic alopecia). At the end of 2 years after commencing finasteride, it was found that 99% of men retained all the hair they had when they first started treatment, while those on placebo (sugar tablets) lost their hair with the balding process. Moreover, 48% of men who was on finasteride actually had more hair at the end of the first year after commencing treatment. At the end of 2 years, 66% had more hair than when they first commenced treatment.

What should I expect to see while on finasteride (Propecia/Proscar) treatment?
The main aim of treatment is to stop you becoming bald. Finasteride arrests hair loss and helps you keep the hair that you have left. In other words, if you do not take finasteride, you would expect to lose more hair over the years. Some men have reduced body hair growth while on higher doses of finasteride.

It is important to manage expectations with finasteride treatment as the main aim is to slow or stop the progression of hair loss rather than expecting hair regrowth. Any regrowth is considered a bonus. Some men actually experience some hair regrowth as early as 4 months after commencing treatment but it usually takes up to 2 years before any regrowth is noticed. Even so, only a third of men on finasteride will actually grow enough hair for their family and friends to notice the difference.

For men who start to go bald in their late teens and early twenties, finasteride is a desirable treatment for many to delay the process as long as possible until their thirties or fourties when they do not mind the prospect of becoming bald after establishing their careers and family lives.

Why am I losing more hair now when I have just started finasteride (Propecia/Proscar)?
On the balding scalp, there are many hairs sitting in the dormant or resting phase on the scalp. Sometimes, finasteride can cause rapid reactivation of the hair follicles to produce new hairs causing the old hairs to be pushed out all at once, so you notice more hair shedding. This is not a serious cause for concern if it happens, and should settle within 6 months. This is an indication that finasteride is having an effect on your hair follicles and "reawakening" them.

What happens if I stop taking finasteride (Propecia/Proscar)?
Once you stop the medication, you will continue to lose your hair and the balding process will take over once again at the same rate had you never have taken finasteride. Finasteride helps to delay this outcome as long as you continue taking this medication.